中老年2型糖尿病周围神经病变患者骨代谢指标变化研究

The correlation between bone biochemical markers and diabetic peripheral neuropathy in middle-aged and elderly patients with type 2 diabetes

目的探讨中老年2型糖尿病合并周围神经病变与骨代谢指标β-CTX、PINP之间的相关性。方法选取遵义医科大学附属医院内分泌科2017年10月至2018年8月的2型糖尿病患者189例,基于患者有无合并周围神经病变进行分组,将患者划分为合并病变组(DPN组)和未合并病变组(NDPN组),两组分别为97例和92例。测定各组FPG、HbA1c、C肽、FIns、HOMA-IR、TG、TC、LDL-C、HDL-C、Ca、P、BMD(L2-L4、Neck、Troch、Ward’s三角)、β-CTX、PINP水平。结果与NDPN组比较,DPN组FPG、HbA1c、FIns、HOMA-IR、TG均高于NDPN组,而P、HDL-C、腰椎L2-L4、股骨颈Neck、Troch处BMD、β-CTX、PINP低于NDPN组(P<0.05);Pearson相关性分析显示,β-CTX与FPG呈负相关(r=0.484,P<0.05);PINP与HDLC、P呈正相关(r分别为0.242、0.309,P<0.05),与HbA1c、HOMA-IR、股骨颈Neck呈负相关(r分别为-0.173、-1.460、-0.237,P<0.05)。结论DPN患者血清β-CTX、PINP水平降低,骨转换指标异常,可能具有更高的骨折风险。

Objective To explore the relationship between type 2 diabetes mellitus with peripheral neuropathy and bone metabolism indexesβ-CTX and PINP.Methods One hundred and eighty-nine patients with type 2 diabetes from October 2017 to August 2018 in the Department of Endocrinology,the Affiliated Hospital of Zunyi Medical University,were selected.They were divided into diabetes with peripheral neuropathy group(DPN group,n=97)and diabetes without neuropathy group(NDPN group,n=92)according to whether they had peripheral neuropathy or not.The levels of FPG,HbA1c,C peptide,TG,TC,LDL-C,HDL-C,Ca,P,BMD(L2-L4,Neck,Troch,and Ward triangle),β-CTX,and PINP were measured.Results Compared with the NDPN group,levels of FPG,HbA1c,FIns,HOMA-IR,and TG were higher,but P,HDL-C,lumbar spine L2-L4,femoral Neck,and Troch BMD,β-CTX,and PINP were lower in the DPN group(P<0.05).Pearson correlation analysis showed thatβ-CTX was negatively correlated with FPG(r=0.484,P<0.05),and PINP was positively correlated with HDLC and P(r=0.242,0.309,P<0.05)and negatively correlated with HbA1c,HOMA-IR and femoral neck Neck(P<0.05).Conclusion The serum levels ofβ-CTX and PINP are reduced,bone turnover is abnormal,and the risk of fracture is higher in DPN patients.